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gastric mucosal atrophy

Thursday 23 February 2012

Taken literally, atrophy means wasting, with resulting reduction in size or amount of an organ, tissue, or cell type.

Atrophy of the stomach affects primarily the glands, which become sparse and small.

In atrophy of the gastric corpus and fundus, parietal cells and chief cells disappear from the oxyntic glands, and the residual glands may undergo pseudopyloric metaplasia.

Mucosal atrophy can be noted grossly, especially in advanced, diffuse atrophy of oxyntic mucosa in the fundus and corpus where rugae disappear and underlying blood vessels become visible.

On the other hand, mucosal thinning is often grossly inapparent in the antrum, probably because its overall thickness is preserved by accompanying inflammation, intestinal metaplasia, or foveolar hyperplasia.

Atrophy is often associated with intestinal metaplasia, but these two features may occur independently of each other.

In pernicious anemia (corpus-predominant atrophic gastritis), there may be little or no intestinal metaplasia in large areas of the atrophic stomach.

In contrast, scattered goblet cells may be found in the surface and foveolar epithelium of many nonatrophic H. pylori-infected stomachs.

When metaplastic epithelium replaces the specialized epithelium of the mucous glands in the antrum or oxyntic glands in the corpus, however, there is actual loss of functional glandular tissue, and therefore true atrophy. In such an instance, atrophy and intestinal metaplasia coincide.

A distinctive form of gastric atrophy occurs in patients who undergo subtotal gastrectomy (antrectomy).

Since there is reduced gastrin stimulation, parietal cells diminish in number in the residual stomach and the oxyntic mucosa becomes thinned.

Staging

Gastric mucosal atrophy is by far the greatest risk factor for non-hereditary, intestinal-type distal gastric cancer (GC).

The gold standard for atrophy assessment is histology, but non-invasive tests (mainly pepsinogen serology) are also applied for this purpose.

According to the current international literature, atrophy is defined as the “loss of appropriate glands”.

This definition covers both the “loss” of native glands (replaced by fibrosis) and the metaplastic replacement of the appropriate (native) glands due to antral intestinalization, corpus antralization [i.e., spasmolytic polypeptide-expressing metaplasia (SPEM)] and/or intestinalization.

Consistent evidence correlates the extent/topography of atrophy with the risk of GC, and it is on these grounds that a system for staging gastritis [the operative link for gastritis assessment (OLGA) staging system] was proposed.

Gastritis stages (0 to IV) express increasing extents of atrophy, as assessed histologically on antral and corpus biopsies.

See also

- gastric intestinal metaplasia
- multifocal atrophic gastritis